abortion017_mac.jpg Monty Patterson of Livermore, holds a photgraph of his 18 year old daughter Holly who died Wednesday after taking the pill ru486, in an affort to try and terminate a pregnany. 9/19/03 in Livermore. MICHAEL MACOR / The Chronicle

A simple change in the technique used to deliver the abortion pill reduced the number of serious infections attributed to the drug by more than half, and dropped infection rates to nearly zero when antibiotics were introduced, according to a study released today.

The results were a welcome relief to abortion providers, who fought for years to get federal approval of the pill in the United States and had faced renewed criticism of the drug after dozens of severe infections were reported and seven women died.

"Our aim was to make a safe procedure even safer," said Mary Fjerstad, lead author of the study, who helped develop Planned Parenthood's strategy for delivering the pill. She left Planned Parenthood earlier this year to work with Ipas, a nonprofit abortion rights group.

The study, published in the New England Journal of Medicine, looked at the use of the abortion pill mifepristone - known as RU-486 - at Planned Parenthood clinics around the country.

4 deaths in California

The controversial pill was approved for use in the United States in 2000 after years of debate. Over the next six years, seven women - four of them in California - died from serious infections after taking the pill, including an 18-year-old Livermore woman whose father urged federal regulators to ban the drug.

In March 2006, Planned Parenthood - the pill's main supplier - announced it was changing the way it delivered the drug. Since then, there have been no reported deaths from the pill and the number of serious infections fell from about 1 per 1,000 to 0.06 per 1,000.

"When medical abortion was first developed, there was an assumption that risk of infection would be nil," Fjerstad said. "We learned over time that actually that's not true, serious infection can occur. You just have to test your assumptions."

Medical abortions - those completed with drugs rather than surgery - have become increasingly popular in the United States and now make up nearly 25 percent of early-term abortions.

The abortion pill is actually two drugs delivered in stages. Women first swallow a dose of mifepristone, which starts the abortion. Two or three days later, usually in their own home, women take a second pill called misoprostol to induce contractions and complete the process.

When the U.S. Food and Drug Administration approved the drug, the agency recommended that women swallow the second pill, which is how the drug typically is taken in Europe. But Planned Parenthood, and many other clinics in the United States, had women insert misoprostol vaginally, based on studies that showed that technique was more effective, causing contractions to start faster and last longer.

Safely used in Europe

There were almost no serious infections in Europe, where the drug is much more popular and has been used for far longer than in the United States. So when U.S. doctors began noticing cases of serious infection, seven of which were fatal, in patients undergoing medical abortions, they considered that the method of delivery was at least partially to blame.

A simple solution

Since March 2006, Planned Parenthood has had women take the second drug by placing it in their mouth, between their cheek and gums, and letting it dissolve. Some researchers say that method retains the effectiveness of the drug, and according to the latest study, it significantly cuts the rate of infection.

"Just changing the route of the misoprostol, which costs nothing, had an effect. And it's certainly no less convenient for women," said Dr. Paul Blumenthal, a professor of obstetrics and gynecology at Stanford University School of Medicine and director of Stanford's Center for Contraceptive Health and Research.

He and other doctors said there's not yet a good explanation for why vaginal insertion seemed to be related to a higher incidence of infection.

Planned Parenthood also changed policies in July 2007, requiring that all women undergoing medical abortions be given antibiotics.

The study looked at nearly 250,000 medical abortions performed between January 2005 and June 2008. In the first 15 months, before the policy change, there were 69 serious infections, which the study defined as infections requiring treatment with intravenous antibiotics. In the final 12 months, after the change in drug delivery and the addition of preventive antibiotic treatment, five serious infections were recorded.

"We'll probably see those practices changed in many clinics around the country," said Dr. Philip Darney, chief of obstetrics and gynecology at San Francisco General Hospital. "Obviously, preventing infection in the first place is the way to go."